Cardiac Doses - Exam 2

Question 1

Adenosine
-class
-dose

Answer 1

-Class IV-like

6mg IV then in a minute or two, 12mg IV if it didn’t work

Question 2

Adenosine
-indications

Answer 2

Ind: pSVT, wide or narrow QRS tachycardias

Question 3

Adenosine
-s/e

Answer 3

transient HB/brady, flushing, cp, N, dizziness, HA

-HoTN, tachycardia, and Bspasm (high doses)

Question 4

Atropine
-dose

Answer 4

0.4-1mg IV

Question 5

Atropine
-indications

Answer 5

bradycardia or AV block

Question 6

Atropine
-S/E

Answer 6

excessive tachycardia, myocardial ischemia

Question 7

Diltiazem
-class
-dose 2 diff sources/doses from workbook

Answer 7

-Class IV
1. 10-20mg IV bolus
-> infusion 5-15mg/hr

2.initial 0.25mg/kg /2min (+EKG +BP)
repeat with 0.35mg/kg after 15 min PRN

AF/flutter: 5-10mg/hr increase by 5mg/hr up to 15mg/hr up to 24hr

Question 8

Diltiazem
-indications

Answer 8

rate control

Question 9

Diltiazem
-s/e

Answer 9

HoTN, CHF

Question 10

Esmolol
-class
-dose 2 diff sources/doses from workbook

Answer 10

-Class II
1. 0.5mg/kg bolus
->infusion 0.05mg/kg/hr
+/- by 0.05mg/kg/hr up to 0.2mg/kg/hr Q 5 min

2.500mcg/kg bolus / 1 min
-> steps of 50,100,150, 200 mcg/min over 5 min each PRN

Question 11

Esmolol
-indications

Answer 11

rapid rate control

Question 12

Esmolol
-s/e

Answer 12

BSpasm, HoTN, exacerbate CHF

Question 13

Metoprolol
-dose

Answer 13

5mg IV Q 5 min x 3

Question 14

Metoprolol
-indication

Answer 14

rate control

Question 15

Metoprolol
-s/e

Answer 15

BSpasm, HoTN, exacerbate CHF

Question 16

Ibutilide
-dose, class

Answer 16

Class III
1mg IV over 10 min (if<60kg = 0.1mg/kg)
repeat 1 x PRN

Question 17

Ibutilide
-indications

Answer 17

convert out of AF

Question 18

Ibutilide
-s/e

Answer 18

QT prolongation, TORSADES, N, HA,HoTN, BBB, AV blk, brady, sustained monomorphic VT, tachy

-don’t mix with other class I or III drugs, amio, or sotalol

Question 19

Amiodarone
-dose

Answer 19

150mg IV /10 min bolus
-> infusion 1mg/hr x 6hr
-> infusion 0.5mg/hr x18hr

Question 20

Amiodarone
-indication

Answer 20

VT/ refractory VT, rate control, convert out of AF

Question 21

Amiodarone
-s/e

Answer 21

mild HoTN (occasionally with boluses), HB

Question 22

Verapamil
-class
-dose

Answer 22

-class IV

5-10mg IV slow push over 2-3min
-repeat up to 2x with 10mg in 10-15min if tolerated

-NAG: start with 2.5mg

Question 23

Dofetilide
-class
-dose

Answer 23

-Class III

250mcg twice daily, MAX 500mcg
twice daily if renal and cardiac function normal

LV dysfunction: 250mcg twice daily

-check QT 2-3hr after, if QTc>15% or >500msec, reduce dose; if QTc>500msec =stop

Question 24

Dofetilide
-pharmacokinetics + metabolism

Answer 24

Pharm: oral peak conc in 2.5hr, steady within 48hr

Metabolism: 50% excreted by kidneys unchanged

Question 25

Dofetilide
-S/E
-CI

Answer 25

S/E:
-TORSADES (3%, keep K+ normal to avoid)
-avoid/reduce dose in altered renal function, brady, or baseline elevated QT
-avoid with other QT prolonging meds

CI: previous torsades, CrCl<20mL/min

Question 26

Dofetilide
-Interactions
-PCNs

Answer 26

Inter: high blood levels ketoconazole, verapamil, cimetidine, or inhibitors of CYP3A4, including macrolide abx, protease inhibitors like ritonavir

PCN:see previous/above

Question 27

Ibutilide
-Pharmacokinetics
-Metabolism

Answer 27

Pharmacokinetics:
-initial dist 1/2 life: 1.5min
-elimination 1/2 life: 6hr

Efficacy ~40min

Question 28

Ibutilide
-CI

Answer 28

previous torsades, decomp HF

Question 29

Ibutilide
-interactions
-PCN

Answer 29

inter: class IA and III antiarrhythmics that prolong QT, antidepressants, macrolide abx,some antihistamines

PCN:check QT, correct hyperkalemia and hypomagnesemia